The last resort

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Treatments prior to surgery

A prosthetic implant is always the last option. All cases of erectile dysfunction are treated in a stepwise manner. Generally, it starts by correcting bad habits and indicating specific drugs. If no improvement is observed in a certain time, the next steps are taken successively until the last option, the penile prosthesis, is reached.

Aetiological diagnosis: Indispensable to indicate a penile implant.

Patient interview: preliminary indications

In order to investigate the possible causes of erectile dysfunction, the interview with the patient is fundamental. Through it, the specialist will consider the patient's medical history as well as different spheres of life (habits, sexuality and psychology). At Andromedi we value three fundamental aspects:

Physiological aspects: Organic causes are ruled out, with emphasis on the cardiovascular system.
Psychological aspects: Through a close conversation, it is ruled out that the dysfunction may be caused by anxiety, stress, depression, sexual fears or lack of confidence.
Sexual health: Specific tests are used to objectively evaluate a patient's sexual performance and satisfaction.

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Physical examination

Once the conversation for diagnostic purposes is over, the specialist will perform a physical examination in which, in addition to measuring your vital signs, emphasis will be placed on the reproductive system in the most professional manner possible and in search of any clue that may suggest the origin of the weak erections.

Analysis and special tests

While it is true that some cases can be diagnosed with a complete clinical history and a comprehensive physical examination, in other situations it is necessary to request laboratory tests, imaging tests and other techniques.

These are the most requested tests in a diagnostic process of erectile dysfunction:

Cardiovascular and neurological evaluation

Given its important association with erection, the physician evaluating erectile dysfunction should check the health of the vascular and cardiac system, especially in men with hypertension, dyslipidemia, obesity or a history of atherosclerosis, who should undergo more specific testing with physicians who are specialists in the field. Likewise, the examination should include a neurological evaluation of motor skills and general sensitivity.

Blood tests

Cholesterol: In the corpora cavernosa of the penis, cholesterol does not cause accumulation, but it does cause damage to the thin endothelium of the blood vessels that are responsible for the physiological mechanism of erection.

Renal function: Renal insufficiency may increase the probability of developing erectile dysfunction, especially due to the accumulation of potentially harmful substances to the capillary endothelium.

Glycemia: It is the main indicator of diabetes and this disease is one of the major causes of ED due to its microvascular and neurological complications.

Testosterone: Testosterone deficiency can affect libido or sexual desire in men and ultimately erectile function.

Intra-cavernous injection test

The specialist will be able to induce “artificial” erections through the injection of vasoactive drugs into the corpora cavernosa of the penis. This makes it possible to evaluate how and to what extent the blood vessels of the penis can produce and maintain an erection. The reading is easy:

If the penis responds to the drug (and becomes erect), the problem may be psychological or otherwise.
If erection does not occur or occurs poorly, the erectile dysfunction is of vascular origin (a very frequent indication for penile prostheses).

Penile echo-Doppler

Echo-Doppler is a non-invasive and inexpensive tool that allows to assess the condition of the penile blood vessels. It is completely painless and helps to understand how erection occurs (or not) within the corpora cavernosa of the penis, as well as to detect venous leaks that “prematurely drain” the blood from the erection.

Cavernosography

This medical imaging test is indicated when the erection problem is related to venous leakage and consists of injecting a radiocontrast substance to visualize whether the dorsal vein of the penis (one of the largest veins of the penis) is allowing blood to be drained before orgasm and ejaculation.

Helical CT angiography

Angio-CTallows to see the blood vessels of the penis, their morphology and their anatomical alterations. These alterations could be the cause of the erection problem.

All penile imaging tests (CT angiography, echo-Doppler and cavernosography) are very useful and highly valued by urologists and andrologists because they help to objectively evaluate the dimensions of the erectile problem and to suggest treatments according to each case, including penile prostheses (when the vascular and anatomical damage is very accentuated and will not respond to conventional therapies).

Erectile dysfunction treatment personalized and staggered

Once the origin of the erection problems has been determined and if the lifestyle intervention did not produce results, specialized and state-of-the-art treatments can be initiated. However, not all cases will follow the same process, each person is evaluated individually and their treatment will be tailored to their characteristics and conditions.

Oral drugs for impotence: phosphodiesterase 5 inhibitors

In most cases, the first intervention is performed with the well-known and widely used phosphodiesterase 5 enzyme inhibitor drugs. They produce powerful erections if taken in a period prior to sexual intercourse and have almost no side effects, so they are very safe to use. Their main representatives are:

Sildenafil (Viagra ®)
Thaladafil (Cialis ®)
Vardenafil (Levitra ®)

Hormonal treatment: testosterone deficiency

Enhance erections
Improve sexual response
Regulates sperm production
Restores libido

Drugs for local application: injections and intraurethral suppositories

Intracavernous injections:

When the pills stop working or are not enough, urologists and treating andrologists recommend the injection of vasoactive drugs (as well as the oral presentation are iPDE5) into the corpora cavernosa of the penis periodically to promote erections and keep the vascular mechanisms of penile rigidity "activated".

Intraurethral suppositories

Vasoactive drugs (iPDE5) can be administered through the urethra. This therapy is less painful than the previous one and is based on the fact that these drugs can be absorbed from the urethral epithelium to the erectile structures and improve the responsiveness to the nerve signals responsible for inducing erection of the member.

The disadvantages of these methods are that in addition to the discomfort of their route of administration (injection into the penis), they require prior training for the patient and, in this case, his or her partner.

Shock wave therapy: impotence of vascular origin

Shockwave therapy is an ideal option for men suffering from erectile dysfunction associated with vascular problems. Its mechanism of action repairs damaged arterial vessels and creates new vascular networks.

In Andromedi we were pioneers in Spain in the implementation of low intensity shock waves as a solution to many cases of male impotence.

A randomized clinical trial published by the American Urological Association in the prestigious journal The Journal of Urology, researchers demonstrated its effectiveness in the treatment of erectile dysfunction.

Twelve sessions over 6 weeks with a treatment protocol of 5,000 pulses, 0.096 mJ/mm2 energy flux density and 5 Hz frequency are highly effective in patients with moderate erectile dysfunction.

Vascular surgery: repair of venous leakage

Venous leakage is a pathological condition in which the veins of the penis are unable to maintain a state of vasoconstriction for the duration of the erection, causing the blood in the corpora cavernosa of the penis to “leak” before the male reaches ejaculation. Penile vascular surgery is indicated in cases of erectile dysfunction due to venous leakage in order to repair the anatomical damage so that the erection is more powerful and lasts as long as it should.

When should we resort to penile prosthesis implant surgery?

There are some direct indications for penile prostheses in which the most conservative steps can be “skipped”, since it is scientifically known that they will not work in certain situations or clinical profiles.

Radical prostatectomy
Serious physical injury to erectile or nerve tissue
Severe diabetes (any type)
Cases of venous leakage in which surgery is not feasible

The penile prosthesis represents a hope for those men who have tried everything and have not been able to recover their erections. Science and technological advances allow us to tell you that erectile dysfunction can be cured regardless of its causes. All men have the opportunity to recover their sexual life and self-confidence. The first step is to accept the problem and seek professional help.